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The drive to care, regardless

14 Dec 2015

A hysterical woman is dumped at perimeter of an Australian Defence Force camp. Her abdomen has been crudely sliced open and then stitched up. Wary soldiers suspect she has been implanted with a live bomb.

A team of volunteer Australian Army Medical Corps doctors, accompanied by a bomb disposal expert, carefully operate on the woman, successfully extracting a land mine that had been inserted behind her rib cage and designed to go off as it was being pulled out.

It is a harrowing but true scene from Mohamed Khadra’s latest book, Honour, Duty, Courage, in which he seeks to answer why doctors and nurses with well-paid jobs and comfortable lives in Australia put it all on hold to go to poor and violent places to help complete strangers.

So who are these men and women, and why do they do it?

After picking at the puzzle for years Professor Khadra, a urological surgeon as well as an author, thinks he has a pretty fair idea.

“These are people driven to put their own needs and wants last,” Professor Khadra, who is head of surgery at Sydney Medical School, says. “They have an innate sense for protecting and nurturing others, and for fairness.”

For the book, Professor Khadra talked extensively to many men and women who have volunteered to serve the Australian Army Medical Corps in deployments that have plunged them into the heart of brutal armed conflicts.

What he found were people with an overriding sense of duty that drove them to serve, both at home and abroad.

“These are the people who are on multiple committees for the hospital, the college and the department. They are the ones who at high school organised charity days,” he says.

Professor Khadra himself shares many of these characteristics – in addition to his clinical work he serves on medical boards and committees, is a senior examiner, a head of department and is an active researcher.

But he says he is “completely humbled” by the selflessness and humanity of those who have served, and continue to volunteer for, army deployments.

“Some people ask what medicine can do for them. These people feel a duty to give back to medicine.”

But Professor Khadra’s account shows that they pay a high personal price for their devotion.

The relentless mental and physical demands of working in a forward medical post, faced daily with the threat of death and evidence of unspeakable depravity, mean anyone who serves in these roles does not leave unchanged.

“I don’t think you can see the atrocities to the depth that they have seen and not come back altered,” he says, though in recent years there has been improvements in support for those returning from service.

Not only do they bear emotional scars, but there is often a financial cost.

Professor Khadra says the payments the volunteers receive can be enough to keep the doors of their private practice open and pay their staff, but little more.

He says that most have only modest financial resources, and when they return after three months’ absence they often have to re-build their practice from scratch because patients have moved on to other practitioners.

To add indignity to the situation, often they face resentment from colleagues who have had to carry a bigger workload during their absence or, in at least one case Professor Khadra knows of, be accused of using their military service to try and drum up business from GPs.

Balanced against these disincentives is the powerful pull of duty.

But will that continue to be enough to ensure the Medical Corps will continue to play the role it has?

Professor Khadra is not sure.

He says there is a perception that those who have entered medicine in the last decade do not have the same sense of duty to give back as those who have come before them – a view fuelled by the difficulty encountered in finding younger colleagues willing to take on teaching duties.

But Professor Khadra is hopeful that, when the time comes, people will continue to step up as have the generations before them.